Welcome to the home page for Integrated Health Clinic’s (IHC) fertility program, and thank you for your interest. I am Dr. Karen Parmar, co-founder of Integrated Health ClinicTM, head of the fertility department at IHC, and practicing doctor of naturopathic medicine since 2000. Fertility has been the primary focus of my practice for the past 15 years, and now I also provide IUD insertions and removals, and female pelvic examinations.
My approach to fertility has evolved and expanded over the past few years, with the addition of prescribing authority for pharmaceutical drugs, and an enhanced scope of practice for naturopathic physicians. It truly has become an integrative approach, encompassing the foundations of wellness (i.e diet, lifestyle, nutrient deficiencies, etc.), with the addition of ovulatory drugs and intrauterine inseminations.
The obstacles to conception are unique to each couple; therefore, I can say that no two treatments are ever the same. From a naturopathic perspective, my aim is to treat the cause (tolle causum), and to allow the patients to regain health, with the goal that successful fertility emerges. This is the goal with each couple, however sometimes this approach is not successful, and other therapies may be warranted.
My intentions are to take each patient through the foundational phases 1-3 of the IHC Fertility Program (see sidebar link), after which more individualized therapies may be prescribed. This may include prescribed bio-identical hormones from a compounding pharmacist (bi-est, tri-est, progesterone, etc.), and ovulatory or superovulatory drugs (i.e. Clomid, Tamoxifen, Human Chorionic Gonadatropin(HCG) injections, etc.). Intrauterine inseminations (IUI) may be recommended if you and your partner meet the eligibility criteria, and if IUI is likely to increase your chances of conceiving.
The path from infertility to fertility is an emotionally difficult journey. We strive to treat each person with the utmost compassion, and we offer customized approaches with the ultimate goal of achieving parenthood.
⇒ Fertility Tests
We encourage you to bring in copies of blood work, diagnostic imaging, IUI/IVF records, sperm testing, HSG results, etc. to your first appointment. Recent blood work/sperm testing (within 3 months) will be requisitioned if needed. IHC utilizes many different laboratories for blood, urine and saliva testing; our lab testing is not covered by MSP, and it is billed directly to the patient. Most extended health plans cover a portion of lab testing; therefore, we would suggest you check with your extended healthcare provider before booking your appointment.
⇒ Fertility Blood Work
Day 2/3 FSH, LH, prolactin, DHEA, testosterone, TSH, free T4, free T3, vitamin B12, ferritin, CBC, and Day 21 progesterone are standard tests required to adequately access basic fertility status. Anti-mullerian hormone may be requested in most women over 35yrs of age. If any lab work ups have been preformed within the last year, please bring in to your visit for the doctor to assess.
⇒ Ovulation Tests
Approaching ovulation is measured by serum LH/estradiol, and urine LH. Day 21/22 serum progesterone can be ordered to confirm an ovulatory cycle. Our patients are often instructed on how to use OPK strips to monitor urinary LH at home. This provides valuable information on timing of intercourse, HCG injections, and timing of IUI appointments.
⇒ Uterus/Ovary Evaluations
All fertility patients will undergo screening ultrasounds throughout their cycles to determine uterine shape/size, and to monitor follicle development, ovulation, uterine lining growth, and blood flow to ovaries and uterus. These ultrasounds are conducted in-house by Dr. Karen Parmar, who has completed additional training in gynecological ultrasound. However, Dr. Parmar is not a sonographer or radiologist, and will not provide diagnostic ultrasounds. Dr. Parmar uses the ultrasound “like a stethoscope, as a medical tool to assess and monitor patients fertility health.” Ultrasounds are usually endo-vaginal, as they provide the best view for follicle measurements and endometrial lining. They do not require a full bladder
⇒ Sperm Testing
Integrated Health Clinic utilizes an in-house health Canada approved SQA-V Gold Sperm Analyzer. The SQA-V is an analytical medical device that performs a complete quantitative evaluation of semen quality and semen parameters in less than 2 minutes. This high performance analyzer incorporates technology in electrooptics, computer algorithms and video microscopy to provide a quick, precise and accurate automated semen analysis.
We encourage you to visit Integrated Health ClinicTM to meet with Dr. Parmar and learn more about these tests.
Integrated Health Clinic provides a whole-person, patient-centered approach to treating infertility, which can be divided into 6 distinct phases.
⇒ Phase 1 – Foundation First
The first visit is 60 minutes in length, and both partners are encouraged to attend. A comprehensive intake, physical exam, and fertility history is taken. Any current or past lab tests, diagnostic imaging, and semen analysis are reviewed. Lifestyle recommendations and diet are addressed. Natural cycle monitoring is initiated.
⇒ Phase 2 – Identify and Remove Obstacles
Blood, urine and saliva tests are ordered, based on patient history, to identifying vitamin/mineral deficiencies, environmental toxicities, endocrine/ hormone imbalances, and ovarian reserve. Ultrasound is used to identify structural abnormalities, uterine lining and ovarian function. Ultrasound monitoring continues throughout cycles to monitor follicle development, ovulation, and changes to cycles.
⇒ Phase 3 – Supplementation/ Nourish
Oral and/or intravenous nutrient replacement therapy, for any fertility-specific vitamins, minerals and amino acids. Herbs to promote ovulation, and to correct subtle hormone imbalances. Based on the results from the semen analysis, male factor infertility is addressed with recommendations to increase sperm concentration, motility, and morphology, decrease leukocytosis and reactive oxygenation species.
⇒ Phase 4 – Balance Hormones
Compounded bio-identical hormone prescriptions may be prescribed for lab-determined hormone imbalances, (ie. Bi-Est, Tri-Est, and Progesterone). These may aid in follicular development, endometrial lining thickness, and luteal phase support. Specific nutritional supplements can influence hormone production pathways to promote conversion to beneficial hormones for fertility, and inhibit the conversion of hormones to less favored hormones.
⇒ Phase 5 – Ovulation Induction/ Superovulation
Utilize pharmaceuticals such as Clomid, Tamoxifen, and HCG for ovulation induction and superovulation. Metformin and Hydrocortisone are also prescribed in certain cases. Ovulation induction is used for those patients who fail to ovulate or have irregular and/or longer cycles. Superovulation is a term used to describe utilizing ovulatory drugs, in a normally cycling woman, with the expectation of creating larger follicles or multiple follicles in that cycle. Ovulation induction and superovulation treatments may cause the risk of conceiving multiples, and may also lead to ovarian hyper-stimulation syndrome, (OHSS). They require physician monitoring and follow up with each cycle is recommended.
⇒ Phase 6 – Non Medicated/ Medicated IUI
Intra-uterine insemination(IUI) is recommended when a couple has failed to conceive after having completed steps 1 through 4 of the IHC Integrative Fertility Program. It is may be combined from the outset during Phase 5, alongside the ovulatory/ superovulatory drugs. IUI may be initially given when the patient is unmedicated, and timed with a woman’s natural LH surge. They also may be prescribed with the use of HCG as a trigger with the LH surge. However, IUI is most often prescribed with an ovulatory or superovulatory drug regimen, as research shows better pregnancy rates with medicated cycles (ie. Clomid, Letrozole, or Tamoxifen). The most common indication for IUI is unexplained fertility, but it is also indicated for infertility secondary to cervical factor, mild male factor, and mild endometriosis. IUI’s are often prescribed for three consecutive cycles/months. If the 3 cycles have been medicated, often a 1-2 month break is recommended before initiating more rounds. If the couple has not conceived after 6 months of IUI treatment, patients are often referred to PCRM or other fertility clinics offering assisted reproductive therapies such as IVF.
For more information on IUI at IHC, please refer to the Q and A page.
We encourage you to visit Integrated Health Clinic to meet with Dr. Parmar and learn more about this program.
⇒ What is the success rate for IUI?
Intrauterine insemination (IUI) when combined with controlled ovarian stimulation reported a five-fold increase in pregnancy rate in comparison to natural cycle.
⇒ What is the cost, and is there a waitlist for IUI?
IUI is offered as part of the IHC fertility program. A new patient visit is required, prior to being offered IUI. The cost is $400 per IUI. Additional visits for ultrasound monitoring, consultation are billed as 15 minute, 30 minute slots. No, there is no waitlist.
⇒ What is an OPK?
An OPK is an ovulation predictor kit and it is used to detect the LH surge in the menstrual cycle. Patients are instructed on how to monitor LH at home during their cycle. OPK kits may be purchased through the clinic, or through a local pharmacy.
⇒ How many IUI’s can I do consecutively?
If the IUI cycles have been medicated (Clomid or Tamoxifen), 3 cycles are completed before a break is taken and the treatment plan is re-assessed. Usually 6 cycles of IUI are completed before moving onto other therapies.
⇒ Do I need to use Clomiphene Citrate or Tamoxifen with IUI?
It is strongly recommended that women take Clomiphene Citrate (Clomid®/Serophene®) or Tamoxifen when doing IUI as it will significantly increase the chances of success.
⇒ Is the procedure painful?
The IUI is relatively painless procedure. It is similar to having a PAP test done.
⇒ Are there restrictions to my activity following IUI?
We have patients lie down for 10-15 minutes following the IUI procedure. After the IUI has been performed, normal activities may resume.
⇒ Is it difficult to give the HCG trigger shot at home?
No it is not difficult to give the trigger shot, once you have received the information for the prescribing doctor. There are some on line videos available to help with the mixing, drawing up, and injecting of the medicine.